You can never be prepared for a diagnosis of breast cancer An excerpt from A Breast Cancer Alphabet. There is a hushed reverence in the waiting area outside the Oval Office. After all those years of The West Wing, one might think there would be a bustle of activity -- a swirl of smart, earnest people walking and talking at the same time. Perhaps I would catch ...

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The patient was a 78-year-old businessman who acted and looked about half his age. He was very pleasant and talked freely about his lower back pain and the pain down the side of his left leg, which had been a problem for about six months. It was consistently more severe when he stood or walked on it, and it immediately disappeared when he sat down. His MRI scan revealed that ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated in the emergency department for a rash that first developed 3 days ago and has rapidly spread to cover most of his body. His skin is painful. He has a history of mild psoriasis and asthma. His psoriasis has been well controlled with topical corticosteroids as needed. ...

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Lucia Sommers of the department of family and community medicine at the University of California, San Francisco commented on my last post, noting that clinical uncertainty among primary care physicians (PCPs) is usually regarded as tolerable at best.  She was delighted that I called such uncertainty intellectually attractive, and something to embrace in psychiatry.  Sommers and her co-author John Launer recently published a book that argues for managing clinical uncertainty in primary care using ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 63-year-old man is evaluated for pleuritic left-sided anterior chest pain, which has persisted intermittently for 1 week. The pain lasts for hours at a time and is not provoked by exertion or relieved by rest but is worse when supine. He reports transient relief with acetaminophen and codeine and occasionally when ...

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Physicians today are challenged with the unique task of navigating the fundamental incompatibility between patient autonomy and the goals of public health. A few months ago, I faced that challenge when my elderly patient declined to receive the recommended influenza vaccine. “I respect my patients’ right to choose, but sometimes I’m concerned that they make choices based on fiction rather fact,” I reflected in a recent post. “It’s been ...

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Concussion expert Dr. A. Chainey Umphrey has assessed the damage youth sports can inflict. He has seen it ruin lives. It happens in one form or another every day: A high school senior leaps to head a soccer ball. She takes an elbow from an opposing player going for the same ball. Woozy, she shakes it off and stays in the game. Six months later, her blistering headaches have subsided but she still experiences ...

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We have long had abundant reason to believe that most of us living in the modern world consume too much sodium and would benefit from consuming less. But whether the topic is salt, or saturated fat, or calories, or even the health effects of consuming vegetables and fruits -- saltation (the jumping from one position to another) seems to be the prevailing inclination in modern nutrition. Certainly it is the ...

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Heisenberg uncertainty principle:  A principle in quantum mechanics holding that increasing the accuracy of measurement of one observable quantity increases the uncertainty with which another conjugate quantity may be known. Perhaps it is because I just got back from Albuquerque, a city which has become like a second home to me, that I have Heisenberg on my mind. For the one or two of you out there who are not Breaking ...

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The danger of diabetes is not only the immediate risk of very high blood sugar. Diabetes also has many dreaded long-term complications. (In this post I am referring to both type 1 and type 2 diabetes mellitus.) Diabetes greatly increases the risk of stroke, heart attack, and amputation. In the US it is the leading cause of kidney failure and of blindness in adults. A study performed by researchers at the ...

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